Carotid artery Doppler ultrasonography in patients with chronic kidney disease

Transcription

1 e-issn DOI: /MSM Reeive: Aepte: Pulishe: Croti rtery Doppler ultrsonogrphy in ptients with hroni kiney isese Authors Contriution: Stuy Design A Dt Colletion B Sttistil Anlysis C Dt Interprettion D Mnusript Preprtion E Literture Serh F Funs Colletion G ABDE 1 Ismil Slk BCDF 2 Gursel Yiliz BEF 1 Hulusi Egilmez ACD 1 Mehmet Hyr Atlr BD 2 Ferhn Cnn CDE 3 Ali Cetin 1 Deprtment of Riology, Cumhuriyet University, Fulty of Meiine, Sivs, Turkey 2 Deprtment of Nephrology, Cumhuriyet University, Fulty of Meiine, Sivs, Turkey 3 Deprtment of Ostetris n Gyneology, Cumhuriyet University, Fulty of Meiine, Sivs, Turkey Corresponing Author: Soure of support: Ismil Slk, e-mil: ismilslk@gmil.om Deprtmentl soures Bkgroun: Mteril/Methos: Results: Conlusions: Key wors: Full-text F: We investigte the hnges in the vlues of roti intim-mei thikness (IMT) n Doppler inex mesurements in the utosoml ominnt polyysti kiney isese (), peritonel ilysis (), n hemoilysis () ptients. Twenty outptients on (men ge 46.1±16.4), 27 outptients on (men ge 45±12.4), n 26 normotensive outptients with (men ge 52.4±16.7) s the se groups n 21 helthy sujets (men ge 48.4±7.2), s the ontrol group, were inlue. The prtiipnts unerwent ultrsonogrphy of the ommon, right, n left roti rteries for the IMT n Doppler flow mesurements. Overll, ompre to the norml group, in the stuy groups, the IMT n pek systoli veloity (PSV), en-istoli veloity (EDV), resistive inex (RI), n pulstility inex (PI) were signifintly higher in ommon roti rteries; however, their ifferenes were not meningful in internl roti rteries (p<.5). Overll,,, n inrese the IMT, PSV, EDV, RI, n PI vlues of CCA; however, their effet onsierle less on the stuy prmeters of ICA. There is no onsierle ifferene mong the effets of,, n on the stuy prmeters. Of CKD ptients uring the first ignosti n follow-up workups, the mesurements of roti IMT n Doppler inies my provie vlule t for improving suess of the linil mngement. roti rteries Doppler ultrsonogrphy intim-mei thikness utosoml ominnt polyysti kiney isese peritonel ilysis hemoilysis Attriution-NonCommeril-NoDerivs 3. Unporte Liense 11 Inexe in: [Current Contents/Clinil Meiine] [SCI Expne] [ISI Alerting System] [ISI Journls Mster List] [Inex Meius/MEDLINE] [EMBASE/Exerpt Mei] [Chemil Astrts/CAS] [Inex Copernius]

2 Slk I. et l.: Croti rtery Doppler ultrsoun Bkgroun Severl riologi stuies re use to evlute the ptient with renl isese. Ultrsonogrphy with Doppler molity is one of the most frequently use tehnique to ssess renl struture n systemi riovsulr iseses in the ignosis n mngement of renl onitions suh s hroni kiney isese (CKD) n polyysti renl normlities. CKD hs een known s n inepenent risk ftor for riovsulr isese, inluing stroke [1,2]. In ition, ptients with CKD often hve numerous tritionl n nontritionl risk ftors for the evelopment of riovsulr isese. Criovsulr iseses re mjor use of moriity n mortlity in ptients with en-stge renl isese (ESRD) [3,4]. Tritionl risk ftors pper to e ssoite with muh lrger solute inreses in risk in the erlier stges of CKD [5]. Hemoilysis () n peritonel ilysis () re ilysis options for ptients with en-stge renl isese (ESRD) in whom preemptive kiney trnsplnttion is not possile [6]. As ontriutors hving potentil to use riovsulr isese, nontritionl risk ftors, inluing perhps hemoilysis proeure itself n the uremi milieu, my e ontriutory [7]. Polyysti kiney isese inlues inherite iseses hrterize y yst formtion n enlrgement in the kiney, eresing kiney funtion irreversile. PKD my hve utosoml ominnt or reessive trit. The utosoml ominnt PKD () is the most ommon geneti vrint of CKD [8,9], t its finl stge, requiring renl replement ommonly [8]. Croti intim-mei thikness (IMT) is known s relile mrker of theroslerosis n preitor of ererovsulr n riovsulr events [1 15]. There is ongoing reserh to ssess the vlue of roti IMT n roti pulstility n resistive inies in ptients with hroni kiney isese [16,17]. There re limite ville stuy investigting the vlue of roti IMT n Doppler inies in the sme linil settings in the,, n ptients [17]. In this stuy, we investigte the hnges in the vlues of roti IMT n Doppler inex mesurements in the, n ptients. Mteril n Methos Written informe onsent ws otine from eh sujet, n the stuy protool ws pprove y the Humn Ethis Committee of our university. In this se-ontrol setting, 2 outptients on (8 femle, 12 mle; men ge 46.1±16.4), 27 outptients on (2 femle, 7 mle; men ge 45±12.4), n 26 normotensive outptients with (11 femle, 15 mle; men ge 52.4±16.7) s the se groups n 21 helthy sujets (11 femle, 1 mle; men ge 48.4±7.2), s the ontrol group, were reruite. All the ptients h fmily history. Oese ptients (oy mss inex =3), ses with ietes mellitus, or unerlying oronry rtery isese n igrette smokers were exlue. The prtiipnts stuie unerwent ultrsonogrphy of the ommon, right, n left roti rteries for the IMT n Doppler flow mesurements. One riologist performe ll ultrsoun exmintions y n ultrsonogrphy evie (Generl Eletri Logi 9; USA) equippe with 1 MHz liner proe s lin to the grouping of sujets. Assessment of IMT Ultrsonogrphi exm ws performe uring sujets in supine position with slight extension of the nek. The CCA IMT ws evlute t the wll of rtery 2 m proximl to its ifurtion. The left n right CCA IMT ws lulte s the men vlue of three iniviul mesurements t ifferent points within the region of interest. Assessment of roti Doppler ultrsonogrphy Ultrsoun exms were performe ptients in supine position. In ll ptients, routine roti US exms inluing grysle n olor n pulse Doppler ultrsoun exmintions of the left n right CCAs n ICAs were onute. All mesurements were me y using ngle orretion. The pek systoli veloity (PSV), en-istoli veloity (EDV), resistive inex (RI), n pulstility inex (PI) were lulte [18]. Sttistil nlysis Dt were expresse s men ±SD. The ultrsonogrphi n Doppler ultrsonogrphi finings were nlyze with ANOVA with post ho Tukey test. Signifine ws etermine t the p<.5 level. Results Figure 1 presents the IMTs of right n left CCAs of the norml,,, n groups. Of left n right CCAs, the IMTs in,, n groups were signifintly higher thn tht of the norml group (p<.5); however, the,, n groups were foun similr with regr to the IMTs (p>.5). Figure 2 shows the PSVs of left (Figure 2A) n right (Figure 2B) CCAs n ICAs of norml,,, n groups. Of left n right CCAs, the PSVs in,, n groups were signifintly higher thn tht of the norml group (p<.5); however, the,, n groups were foun omprle with regr to the PSVs (p>.5). The norml,,, n groups were similr with regr to the PSVs of left n right ICAs (p>.5). Attriution-NonCommeril-NoDerivs 3. Unporte Liense 12 Inexe in: [Current Contents/Clinil Meiine] [SCI Expne] [ISI Alerting System] [ISI Journls Mster List] [Inex Meius/MEDLINE] [EMBASE/Exerpt Mei] [Chemil Astrts/CAS] [Inex Copernius]

3 Slk I. et l.: Croti rtery Doppler ultrsoun DIAGNOSTIC TECHNIQUES Intim-mei thikness (mm) Figure 1. Intim-mei thiknesses of right n left ommon roti rteries of stuy groups. Dt were expresse s men ±SD., right ommon roti rtery;, left ommon roti rtery;, ult polyysti kiney isese;, peritonel ilysis;, hemoilysis., P<.5 vs.,, n groups.. Pek systoli veloity (m/sn) A Figure 2. Pek systoli veloities of left (A) n right (B) ommon n internl roti rteries of stuy groups. Dt were expresse s men ±SD., left ommon roti rtery;, left internl roti rtery;, Right ommon roti rtery;, right internl roti rtery;, ult polyysti kiney isese;, peritonel ilysis;, hemoilysis., P<.5 vs.,, n groups. B 15 Pek systoli veloity (m/sn) 1 5 Figure 3 shows EDVs of left (Figure 3A) n right (Figure 3B) CCAs n ICAs of the norml,,, n groups. Of left CCAs, the EDV in group ws signifintly higher thn those of the norml,, n groups (p<.5); n the EDVs in n groups were signifintly higher thn tht of the norml group (p<.5); however, there ws no signifint ifferene etween the n groups with regr to the EDV (p>.5). The EDVs of left ICAs of,, n groups were signifintly higher thn tht of the norml group (p<.5); however, there ws no signifint ifferene mong the,, n groups (p>.5). Of right CCAs n ICAs, the EDV in n groups were signifintly higher thn those of the norml n groups (p<.5); however, there ws no signifint ifferene mong the norml n groups (p>.5). Figure 4 shows RIs of left (Figure 4A) n right (Figure 4B) CCAs n ICAs of the norml,,, n groups. Of left n right CCAs, the RIs in the group were signifintly higher thn those of the other groups (p<.5); the RIs of the n groups were signifintly higher thn tht of the norml group (p<.5); however, the n groups were similr with regr to the RIs (p>.5). The norml,,, n groups were similr with regr to the RIs of left n right ICAs (p>.5). Figure 5 shows pulstility inies of left (Figure 5A) n right (Figure 5B) CCAs n ICAs of the norml,,, n groups. Of left CCAs, the PI in the group ws signifintly higher thn those of the norml,, n groups (p<.5); n the PIs in the n groups were Attriution-NonCommeril-NoDerivs 3. Unporte Liense 13 Inexe in: [Current Contents/Clinil Meiine] [SCI Expne] [ISI Alerting System] [ISI Journls Mster List] [Inex Meius/MEDLINE] [EMBASE/Exerpt Mei] [Chemil Astrts/CAS] [Inex Copernius]

4 Slk I. et l.: Croti rtery Doppler ultrsoun A En istoli veloity (m/sn) B En istoli veloity (m/sn) e e Figure 3. En-istoli veloities of left (A) n right (B) ommon n internl roti rteries of stuy groups. Dt were expresse s men ±SD., left ommon roti rtery; left internl roti rtery;, Right ommon roti rtery;, right internl roti rtery;, ult polyysti kiney isese;, peritonel ilysis;, hemoilysis. P<.5 vs. norml,, n groups. P<.5 vs. norml group. P<.5 vs.,, n groups.,e P<.5 vs. norml n groups. A Resistive inex Figure 4. Resistive inies of left (A) n right (B) ommon n internl roti rteries of stuy groups. Dt were expresse s men ±SD., left ommon roti rtery; left internl roti rtery;, Right ommon roti rtery;, right internl roti rtery;, ult polyysti kiney isese;, peritonel ilysis;, hemoilysis., P<.5 vs. norml,, n groups., P<.5 vs. norml group. B 1. Resistive inex signifintly higher thn tht of the norml group (p<.5); however, the n groups were similr with regr to the PIs (p>.5). Of right CCAs, the PIs in the,, n groups were signifintly higher thn tht of the norml group (p<.5); however, the,, n groups were similr with regr to the PIs (p>.5). The stuy groups were similr with regr to the PIs of left n right ICAs (p>.5). Disussion In this stuy, we ssesse the hnges in the roti IMT n Doppler inex mesurements in the, n ptients s ompre to the helthy ontrols. Of left n right CCAs, the IMT n PSV vlues were foun inrese ue to, n ; however, the IMTs n PSVs of, n were Attriution-NonCommeril-NoDerivs 3. Unporte Liense 14 Inexe in: [Current Contents/Clinil Meiine] [SCI Expne] [ISI Alerting System] [ISI Journls Mster List] [Inex Meius/MEDLINE] [EMBASE/Exerpt Mei] [Chemil Astrts/CAS] [Inex Copernius]

5 Slk I. et l.: Croti rtery Doppler ultrsoun DIAGNOSTIC TECHNIQUES A B 3 Pulstility inex Figure 5. Pulstility inies of left (A) n right (B) ommon n internl roti rteries of stuy groups. Dt were expresse s men ±SD., left ommon roti rtery; left internl roti rtery;, Right ommon roti rtery;, right internl roti rtery;, ult polyysti kiney isese;, peritonel ilysis;, hemoilysis. P<.5 vs. norml,, n groups. P<.5 vs. norml group. P<.5 vs.,, n groups. Pulstility inex 2 1 foun omprle. Of left n right ICAs, the PSVs of ICAs were foun similr. Of left CCAs, the EDV in group ws foun more ompre to the other groups; n the EDVs in n groups were foun more ompre to the norml group; however, the n groups were foun omprle with regr to the EDV. The EDVs of left ICAs of CKD groups were foun inrese ompre to the norml group; however, the EDVs of CKD groups were foun similr. Of right CCAs n ICAs, the EDV in n groups were foun inrese ompre to the norml n groups; however, the norml n groups were foun omprle with regr the EDV. Of left n right CCAs, the RIs in the group were foun higher ompre to the norml,, n groups; the RIs of the n groups were foun higher ompre to the norml group; however, the n groups were similr with regr to the RIs. All the stuy groups were similr with regr to the RIs of left n right ICAs. Of left CCAs, the PI in the group ws foun higher ompre to the other groups; n the PIs in the n groups were foun higher ompre to the norml group; however, the n groups were similr with regr to the PIs. Of right CCAs, the PIs in the CKD groups were foun higher ompre to the norml group; however, the CKD groups were similr with regr to the PIs. The stuy groups were omprle with regr to the PIs of left n right ICAs. In ESRD ptients, riovsulr isese is the mjor use of eth, n the iniene of theroslerosis-relte omplitions is signifintly higher if ilysis require. The serious use of moriity n mortlity is therosleroti vsulr mge in ESRD ptients [17,19]. ESRD my inue enothelil ysfuntion tht is n importnt ontriutor of the evelopment of theroslerosis [2] n my result in n inrese in the iniene of importnt therosleroti events suh s ute myoril infrtion n stroke [21] Ientifition of risk ftors for n ptients is importnt in orer to estlish preventive n interventionl strtegies. In generl, it is suitle to ssume tht the tritionl riovsulr risk ftors for the generl popultion re lso pplile to the ptients, n tht ptients suffer more riovsulr iseses euse these risk ftors re present more ommonly [7]. In ptients hving no linil omplints, therosleroti hnges n e etete s three min mnifesttions on vessel wlls: inresing IMT, plque formtion n ltertions in rteril hemoynmis; however, the most pplile of them is the mesurement of IMT ue to its simpliity n reprouiility in the linil prtie [22]. Tnk et l. [16] to ssess whether roti IMT is ssoite with CKD, n whether renl ysfuntion is ssoite with lifie plque in roti rteries. Their stuy inlue 13 ptients ge 5 yers who unerwent roti ultrsonogrphy. In their stuy, kiney funtion ws evlute se on the estimte glomerulr filtrtion rte (egfr) n the presene of proteinuri. They exlue ESRD ptients. They ssesse roti IMTs, n exmine the hrteristis of the mximl plques y roti ultrsonogrphy. They foun tht egfr ws signifintly orrelte with roti IMT vlues. They note tht reue egfr, proteinuri, ge, mle sex, riovsulr isese, hypertension, ietes, n smoking were inepenently ssoite with roti IMT finings. They onlue tht there ws Attriution-NonCommeril-NoDerivs 3. Unporte Liense 15 Inexe in: [Current Contents/Clinil Meiine] [SCI Expne] [ISI Alerting System] [ISI Journls Mster List] [Inex Meius/MEDLINE] [EMBASE/Exerpt Mei] [Chemil Astrts/CAS] [Inex Copernius]

6 Slk I. et l.: Croti rtery Doppler ultrsoun n ssoition etween the egrees of roti theroslerosis n CKD. In our stuy, we evlute roti theroslerosis in ptients with CKD requiring hemoilysis n ontinuous multory peritonel ilysis. Krmn et l. [17] investigte tht the reltionship etween roti IMT n PI or RI vlues in hemoilysis ptients. They foun tht the roti IMT of hemoilysis ptients were inrese ut PI n RI erese in hemoilysis ptients; however, they etermine wek ut negtive orreltion etween only right IMT n right PI. They onlue tht PI RI vlues lower thn expete in hemoilysis ptients. They suggeste tht peripherl vsoilttion relte to nemi might e the use of those lower vlues. Aoring to our knowlege there is no other stuy investigting roti IMT n Doppler inies in the n ptients. Cheung et l. [7] hve onute stuy etermining the prevlene n severity of therosleroti riovsulr iseses in representtive hroni hemoilysis popultion. In their stuy, they hve ssesse the reltionship etween severl tritionl riovsulr isese risk ftors n the presene or history of riovsulr events in 936 hemoilysis ptients. They hve onlue tht there ws high prevlene of therosleroti riovsulr iseses in the hroni hemoilysis ptients n tht severl of the tritionl oronry risk ftors in the generl popultion ppere to e pplile to the hemoilysis popultion. Hell et l. [4] hve evlute the effets of n on the riovsulr risk. They foun the mrke teneny of ptients with impire renl funtion for eveloping riovsulr iseses, irrespetively of the type of ilysis. They suggeste tht the inlusion of uremi-relte risk ftors in the pnel for evlution of riovsulr risk in ilysis ptients ws require. Nkym et l. [23] hve evlute whether the roti rtery lifition t the initition of hemoilysis ws risk ftor for riovsulr events in 133 ptients with en-stge renl isese. They hve onfirme the roti rtery lifition t the initition of hemoilysis s n inepenent risk ftor for susequent riovsulr events in ptients with ESRD. Turkmen et l. [24] hve investigte the roti IMT n oronry flow veloity reserve in ptients. Normotensive ptients with with well-preserve renl funtion hve signifintly inrese roti IMT n signifintly erese oronry flow veloity reserve ompre with helthy prtiipnts. They hve suggeste tht theroslerosis strts t n erly stge in the ourse of their isese in ptients. Our finings relte to the IMT in ptients re in orne with those finings. Conlusions Overll, oring to our finings,,, n inrese the IMT, PSV, EDV, RI, n PI vlues of CCA; however, they use no meningful inrese in the IMT, PSV, EDV, RI, n PI vlues of ICA. There is no onsierle ifferene mong the effets of,, n on the IMT, PSV, EDV, RI, n PI vlues. Of CKD ptients uring the first ignosti workup n t the regulr follow-ups, the mesurement of roti IMT n Doppler inies my provie vlule t helpful for etermining suess of the linil mngement. Future stuies inluing roti rtery imging with olor Doppler ultrsoun in higher numer of, n ptients re neessry to etermine the impt of risk ftors, espeilly relte to the type of ilysis, on therosleroti riovsulr isese n to reue these risk ftor s strtegy for preventing riovsulr isese in, n ptients. Referenes: 1. Go AS, Chertow GM, Fn D et l: Chroni kiney isese n the risks of eth, riovsulr events, n hospitliztion. N Engl J Me., 24; 351(13): Anvekr NS, MMurry JJ, Velzquez EJ et l.: Reltion etween renl ysfuntion n riovsulr outomes fter myoril infrtion. N Engl J Me, 24; 351(13): Yilmz FM, Aky H, Durny M et l: Croti theroslerosis n riovsulr risk ftors in hemoilysis n peritonel ilysis ptients. Clin Biohem, 27; 4(18): Hell I, Smoui W, Hmi FB et l: Criovsulr risk ftors in hemoilysis n peritonel ilysis ptients.sui J Kiney Dis Trnspl, 21; 21(1): Shlipk MG, Frie LF, Cushmn M et l: Criovsulr mortlity risk in hroni kiney isese: omprison of tritionl n novel risk ftors. JAMA, 25; 293(14): Sinnkirouhenn R, Holley JL: Peritonel ilysis versus hemoilysis: risks, enefits, n ess issues. Av Chroni Kiney Dis, 211; 18(6): Cheung AK, Srnk MJ, Yn G et l: Atherosleroti riovsulr isese risks in hroni hemoilysis ptients. Kiney Int, 2; 58(1): Ptel V, Chowhury R, Igrshi P: Avnes in the pthogenesis n tretment of polyysti kiney isese. Curr Opin Nephrol Hypertens, 29; 18(2): Bru M, Cil O, Pterson AD et l: Fmily history of renl isese severity preits the mutte gene in. J Am So Nephrol, 29; 2(8): Desien AM, Chonhol M, Gnhn H, Sner D: Kiney funtion n progression of roti intim-mei thikness in ommunity stuy. Am J Kiney Dis, 28; 51(4): Zhng L, Zho F, Yng Y et l: Assoition etween roti rtery intimmei thikness n erly-stge CKD in Chinese popultion. Am J Kiney Dis, 27; 49(6): Hue JC, Bzn R, Pereir Brg G et l: Croti rtery therosleroti profile s preitor of the ort therosleroti profile in ptients with ererovsulr events. Cererovs Dis, 213; 36(1): Miezkowsk J, Mosiewiz J, Sk J et l: Effets of igrette smoking, metoli synrome n ehyroepinrosterone efiieny on intim-mei thikness n enothelil funtion in hypertensive postmenopusl women. Me Si Monit, 212; 18(4): CR Attriution-NonCommeril-NoDerivs 3. Unporte Liense 16 Inexe in: [Current Contents/Clinil Meiine] [SCI Expne] [ISI Alerting System] [ISI Journls Mster List] [Inex Meius/MEDLINE] [EMBASE/Exerpt Mei] [Chemil Astrts/CAS] [Inex Copernius]

7 Slk I. et l.: Croti rtery Doppler ultrsoun DIAGNOSTIC TECHNIQUES 14. Dzierw K, Pienizek P, Musilek P et l: Tretment strtegies in severe symptomti roti n oronry rtery isese. Me Si Monit, 211; 17(8): RA Musilek P, Pienizek P, Trz W et l: Sfety of emoli protetion evie-ssiste n unprotete intrvsulr ultrsoun in evluting roti rtery therosleroti lesions. Me Si Monit, 212; 18(2): MT Tnk M, Ae Y, Furuko S et l: Chroni kiney isese n roti theroslerosis. J Stroke Cererovs Dis, 212; 21(1): Krmn O, Alyrk R, Coly M et l: Croti hemoynmi prmeters in hemoilysis ptients. Int Urol Nephrol, 28; 4(3): Lee VS, Hertzerg BS, Workmn MJ et l: Vriility of Doppler US mesurements long the ommon roti rtery: effets on estimtes of internl roti rteril stenosis in ptients with ngiogrphilly prove isese. Riology, 2; 214(2): Pszio L, Bino F, Giorgini A et l: Eho olor Doppler imging of roti vessels in hemoilysis ptients: eviene of high levels of therosleroti lesions. Am J Kiney Dis, 1996; 28(5): Thmyrjh J, Lnry MJ, MGlynn FJ et l: Anormlities of enothelil funtion in ptients with preilysis renl filure. Hert, 2; 83(2): Iseki K, Fukiym K: Long-term prognosis n iniene of ute myoril infrtion in ptients on hroni hemoilysis. The Okinw Dilysis Stuy Group. Am J Kiney Dis, 2; 36(4): Jursi MJ, Lovreni-Huzjn A, Beekovi MR, Demrin V: How to monitor vsulr ging with n ultrsoun. J Neurol Si, 27; 257(1 2): Nkym M, Ur Y, Ngt M et l: Croti rtery lifition t the initition of hemoilysis is risk ftor for riovsulr events in ptients with en-stge renl isese: ohort stuy. BMC Nephrol, 211; 12: Turkmen K, Oflz H, Uslu B et l: Coronry flow veloity reserve n roti intim mei thikness in ptients with utosoml ominnt polyysti kiney isese: from impire tuules to impire roti n oronry rteries. Clin J Am So Nephrol, 28; 3(4): Attriution-NonCommeril-NoDerivs 3. Unporte Liense 17 Inexe in: [Current Contents/Clinil Meiine] [SCI Expne] [ISI Alerting System] [ISI Journls Mster List] [Inex Meius/MEDLINE] [EMBASE/Exerpt Mei] [Chemil Astrts/CAS] [Inex Copernius]